Provider Demographics
NPI:1265517221
Name:MICHITSCH, MICHELLE RENEE (CPNP-PC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RENEE
Last Name:MICHITSCH
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 REDWING LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-2132
Mailing Address - Country:US
Mailing Address - Phone:516-520-1947
Mailing Address - Fax:
Practice Address - Street 1:175 FULTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3718
Practice Address - Country:US
Practice Address - Phone:516-292-1034
Practice Address - Fax:516-292-0565
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381247363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics